AUTHOR=Li Jinzhang , Li Lei , Wang Maozhou , Li Haiyang , Sun Lizhong , Liu Yongmin , Fan Ruixin , Zhang Zonggang , Zou Chengwei , Zhang Hongjia , Gong Ming TITLE=Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=Volume 8 - 2021 YEAR=2021 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.689507 DOI=10.3389/fcvm.2021.689507 ISSN=2297-055X ABSTRACT=Background It is unclear whether the total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and hybrid debranching surgery have a difference in the prognosis of patients with type A acute aortic syndrome (AAS). We attempted to compare the short-term and long-term prognosis of total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and hybrid debranching surgery in patients with type A acute aortic syndrome (AAS). Methods From January 2014 to September 2020, a total of 518 patients who underwent TAR with FET surgery and 31 patients who underwent hybrid surgery were included. We analyzed the postoperative mortality and morbidity of complications of the two surgical methods, and we determined 67 patients for subgroup analysis through a 1:2 propensity score match (PSM). We identified risk factors for patient mortality and postoperative neurological complications through multivariate regression analysis. Results Compared with the TAR with FET group, hybrid surgery could reduce aortic cross-clamp time, reduce intraoperative blood loss and prevent some patients from cardiopulmonary bypass. There was no significant difference in 30-day mortality between the TAR with FET group and the hybrid surgery group (10.6% vs 9.7%). However, hybrid surgery had increased the incidence of permanent neurological complications in patients (95%CI: 4.7%-35.7%, P=0.001), especially postoperative cerebral infarction (P<0.001). During the average follow-up period of 31.6 months, there was no significant difference in the 1-year survival rate and 3-year survival rate between the TAR with FET group and the hybrid surgery group (P=0.811), but hybrid surgery increased the incidence of long-term neurological complications(P<0.001). In multivariate regression analysis, surgical methods were not a risk factor for postoperative deaths, but hybrid surgery was a risk factor for postoperative neurological complications (P<0.001). Conclusions Hybrid surgery is an acceptable treatment for AAS, and its postoperative mortality is similar to FET. But hybrid surgery may increase the risk of permanent neurological complications after surgery, and this risk must be carefully considered when choosing hybrid surgery.